| NPI | 1124484969 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: MN s173) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: OH 30.024914) |
| Enumeration Date | 2016-01-09 |
| Last Update Date | 2022-01-05 |